Management of Nose Bleeding in Older Adults

What Is a Nosebleed?

A nosebleed, also known as epistaxis, is the loss of blood from the nose. Usually, nosebleeds are mild and can be managed at home, but some can be recurrent or severe and occur due to a serious underlying condition. The blood vessels inside the nose are fragile and can bleed easily during an injury. It can occur in one or both nostrils but is more common in one nostril. Nose bleeding in older people occurs as a result of the natural aging process. There are two types of nose bleeding:

1. Anterior Nosebleed: It starts in front of the nose at the lower part of the nasal septum or the wall that separates two sides of the nose. Anterior nosebleed is the most common type.

2. Posterior Nosebleed: It is caused by the damage of larger blood vessels in the back of the nose near the throat. Posterior nosebleeds commonly occur in adults.

What Are the Causes of Nosebleeds?

The most common cause of nosebleeds is dry air. People living in dry weather experience the drying of the nasal membrane or the thin tissue inside the nose, which can result in crusting. This produces irritation and tempts the person to scratch more, resulting in bleeding.

Other causes of nosebleeds are:

• Nose picking.

• Foreign objects stuck in the nose.

• Allergic reactions.

• Chemical irritants.

• Frequent sneezing.

• Injury to the nose or whole face.

• Cold or upper respiratory tract infections.

• Coughing.

• Nose blowing.

• Drugs like cocaine inhaled through the nose.

• Deviated nasal septum or irregular shape of the wall that separates two parts of the nose.

The causes of nose bleeding in older people are:

1. Medications: Blood thinning medications or anticoagulants like Aspirin have the property to reduce the formation of blood clots. This can increase the risk of nose bleeding, even during nose picking or blowing.

2. Underlying Medical Condition: Heart diseases like congestive heart failure and high blood pressure can damage the blood vessels that induce nose bleeding. Kidney and liver diseases are considered the most common causes of nose bleeding in older people. Some diseases like leukemia or other cancers may have nose bleeding as an initial sign.

3. High Altitude: The amount of oxygen decreases at higher altitudes which can dry up the nasal membranes, and its severity is more in older people as compared to young adults.

4. Respiratory Infection: The inner lining of the nose can get irritated by upper respiratory tract infections that may result in bleeding.

5. Surgery on the Face or Nose: Minor bleeding is common after facial or nasal surgery as part of the healing process. However, in older people, the healing process is very slow and can result in more bleeding.

How Is a Nosebleed Diagnosed?

• The doctor will inquire about the duration and frequency of bleeding, whether bleeding is present in both nostrils, and the approximate amount of blood lost through the nosebleed.

• After that, the doctor will ask about the medications patients take, such as whether they are taking medicines like Aspirin, Warfarin, and NSAIDs (non-steroidal anti-inflammatory drugs).

• Family history of bleeding disorders or cancers will be inquired.

• Following that, the doctor will thoroughly examine the nose using a light source and a nasal speculum. Light sources can be a pen torch, head torch, or otoscope. The nasal speculum is a medical device that is used to inspect the anterior or front part of the nose. It helps in widening the nostril to get a clear view of the inside of the nose. It is commonly used in diagnosis as well as to do certain procedures in the nose. If any blood clots or crusts are present, they will be removed.

• CT (computed tomography) or MRI (magnetic resonance imaging) scans and blood tests will be advised if the doctor suspects any bleeding disorder or cancer.

How Is a Nosebleed Treated in Older Adults?

It is important to take treatment if there is severe nose bleeding or it does not stop for 20 minutes. The following are the common treatments to reduce nose bleeding:

• Cauterization: Nasal cautery or nose cauterization is a medical procedure used to treat nose bleeds. A small cautery stick made of silver nitrate and heat energy is used to seal bleeding vessels, stopping the bleeding.

• Nasal Packing: In nasal packing, layers of gauze are placed in the nose to provide pressure to stop bleeding. It is carried out under local anesthesia. It is removed after two to three days.

• Adjustment of Medications: Adjusting the doses of blood thinners under doctor's prescriptions may be useful.

• Surgery: If a broken nose or deviated nasal septum is the cause of nose bleeding, then surgery is a great option to correct it.

• Ligation: In this procedure, the blood vessel which is responsible for bleeding is tied off to stop bleeding.

How to Manage or Stop Nosebleeds?

• Carry a tissue or damp cloth every time to catch the blood.

• During a nosebleed, breathe through the mouth.

• Sit straight and slightly bend the body and head forward. This can stop bleeding for a while.

• Pinch the nose for five minutes. If the bleeding continues, then pinch it for another ten minutes.

• Do not rub or blow the nose for a few days until the bleeding stops.

• Apply an ice pack to the bridge of the nose. This will help constrict the blood vessels and slow down bleeding.

How to Prevent a Nosebleed in Older Adults?

• Avoid nose picking and keep the fingernails well-trimmed.

• Do not put any pins or other foreign objects in the nose.

• Keep a humidifier in the bedroom to bring a humid environment while sleeping.

• Always keep the nasal passages moist. For this, saline nasal spray or drops can be used two times a day.

• Limit the over-the-counter use of Aspirin and other NSAIDs. However, do not make any adjustments to the prescribed medications by the doctor.

• Avoid smoking, as smoking can cause dryness in the nose.

• Always wear protective headgear or head guard while doing certain activities that may cause injuries to the nose or face.

Conclusion

Nose bleeding in older people can occur due to natural aging or underlying health conditions. Sometimes, it can be a very unpleasant feeling and may affect an individual’s daily life. Seniors who take blood thinner medications and those with liver and kidney problems are at the highest risk for nose bleeding or epistaxis. If an individual experience heavy nose bleeding or bleeding extending for more than 20 minutes, immediate treatment must be considered. However, nose bleeding during old age can be prevented by taking certain precautions.